June 12, 2014
By Hendrik van der Breggen
The Carillon, June 12, 2014
Is it wise to legalize euthanasia (a.k.a. physician-assisted suicide/ doctor-assisted death)? I doubt it, for five reasons.
1. The popular argument for euthanasia hinges on a false dichotomy: euthanasia or painful death. Significantly, there's a third option: palliative care.
Doris Barwich, M.D., President of Canadian Association of Palliative Care Physicians: "Pain is rarely the reason patients ask for hastened death—it more often comes out of a desire to control the circumstances surrounding death. Fortunately, we can assure our patients that with Palliative Care tools and resources, pain and other distressing symptoms can usually be controlled and support provided to ensure comfort and quality of life."
2. Instead of euthanasia for the (rare) difficult cases, there is palliative sedation.
Journal of the American Medical Association: "Palliative sedation is the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious (as in a deep sleep) while the disease takes its course, eventually leading to death. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life."
If, foreseeably, palliative sedation hastens death, it needn't be judged unethical. According to ethicist Margaret Somerville, just as death isn't the intended effect of high risk surgery (needed to relieve pain), and so such surgery isn't immoral if death occurs, so too if death isn't the intended effect of high risk pain management, yet death occurs, then such pain management isn't immoral either.
There's an important moral difference between engaging in a procedure with intent to kill (euthanasia) rather than not (palliative sedation). Euthanasia takes the lower moral ground.
3. Allowing terminally ill patients to die from their illness via termination of life support by withdrawing/ withholding extraordinary, burdensome, or medically useless treatment is already a legal and ethical part of palliative care—and doesn't require euthanasia.
Ethicist Scott Rae: "Physicians need not always 'do everything' to stave off death, especially when it involves no more than simply delaying an inevitable death…. Choices about CPR, respirators, and intravenous procedures in the last weeks of life should not be viewed as choices for death."
Euthanasia isn't needed, in other words.
4. Euthanasia imposes a terrible burden on the vulnerable. If life is no longer society's default position, then the most vulnerable members of our society—the elderly, terminally ill, disabled—must justify their continued existence.
This is just plain nasty.
5. According to philosopher Paul Chamberlain, a logical-legal slippery slope looms large.
Consider the notion of patient autonomy and the fact that reasons for one action sometimes also justify unintended actions.
In the context of legalized euthanasia, patient autonomy becomes understood in terms of the following fundamental principle: the sufferer has the right to doctor-assisted death to end his/her suffering.
Significantly, accepting euthanasia as a legal right on the basis of this fundamental principle opens up and justifies many other situations in which persons suffer and request death. These situations include the non-terminally ill, the elderly, the disabled, persons with chronic back pain, the depressed teenager, etc.
Trust legislative safeguards for protection? Good luck. Aside from abuse (one third of Belgium's euthanasia deaths were illegal and lacked patient consent), safeguards fail because courts will do what courts do—promote consistency. Consistency demands that all of the above-mentioned persons, if suffering, and if desiring death (and if represented by a smart lawyer), can be reasonably seen to have the right to death as well.
After all, at the core of these other situations is a sufferer who requests doctor-assisted death, rendering situational differences incidental.
Legalizing euthanasia, then, puts us on a non-fallacious slippery slope that embraces death as a solution.
But medical, social, and psychological problems require medical, social, and psychological solutions—not killing.
Surely, legalizing euthanasia is not wise.
(Hendrik van der Breggen, PhD, is associate professor of philosophy at Providence University College.)
P.S. For further reading on euthanasia/ physician-assisted suicide, see the following APOLOGIA columns: